Adverse effects NCLEX-RN Practice Questions

Adverse effects NCLEX-RN Practice Questions sharpen your ability to recognize, prioritize, and manage medication-related complications within the Pharmacological & Parenteral Therapies domain. These questions focus on early detection of life-threatening reactions (e.g., anaphylaxis, angioedema), dose-related toxicities (e.g., digoxin, lithium, theophylline), infusion-related syndromes (e.g., red man syndrome), and hematologic, hepatic, renal, and neuroendocrine adverse effects. You will also review IV complications such as infiltration/extravasation and high-risk combinations that precipitate serotonin syndrome, hypertensive crisis, or excessive bleeding. Each item emphasizes assessment cues, critical lab thresholds, safe nursing actions, and escalation strategies. Use these NCLEX-level questions to build clinical judgment, anticipate complications, and intervene promptly to protect patient safety.

Q1. A client taking lisinopril reports swelling of the lips and tongue and difficulty swallowing. Which action should the nurse take first?

• Notify the provider and document the reaction at the end of the shift
• Administer diphenhydramine and continue monitoring the client
• Discontinue the medication, maintain airway, and prepare for possible epinephrine
• Reassure the client that cough is a common side effect of ACE inhibitors

Correct Answer: Discontinue the medication, maintain airway, and prepare for possible epinephrine

Q2. A client on warfarin presents with bleeding gums and an INR of 4.8. What is the nurse’s priority action?

• Administer the next dose of warfarin as scheduled
• Hold warfarin and prepare to administer vitamin K per orders
• Encourage increased intake of leafy green vegetables immediately
• Document findings and recheck INR in one week

Correct Answer: Hold warfarin and prepare to administer vitamin K per orders

Q3. A client on unfractionated heparin has platelets that dropped from 250,000 to 80,000/mm³ in two days. Which action is most appropriate?

• Increase the heparin infusion rate to maintain anticoagulation
• Stop heparin immediately and notify the provider of suspected HIT
• Administer aspirin to prevent further clot formation
• Switch to low-molecular-weight heparin and continue therapy

Correct Answer: Stop heparin immediately and notify the provider of suspected HIT

Q4. During a vancomycin infusion, the client develops flushing of the face and neck, pruritus, and hypotension. What is the nurse’s first action?

• Stop the infusion and assess the client’s airway and vital signs
• Continue the infusion and administer acetaminophen
• Document a penicillin allergy in the medical record
• Increase the infusion rate to finish more rapidly

Correct Answer: Stop the infusion and assess the client’s airway and vital signs

Q5. A postoperative client on morphine PCA is difficult to arouse with a respiratory rate of 8/min and SpO₂ of 88%. Which intervention is priority?

• Increase IV fluids to enhance circulation
• Stop the PCA, stimulate the client, and prepare to administer naloxone
• Reposition the client and continue to monitor
• Encourage deep breathing and coughing exercises

Correct Answer: Stop the PCA, stimulate the client, and prepare to administer naloxone

Q6. A client taking clozapine reports sore throat and fever. Which laboratory result requires the most immediate action?

• Absolute neutrophil count 900/mm³
• Hemoglobin 11.8 g/dL
• Platelets 170,000/mm³
• WBC 7,800/mm³

Correct Answer: Absolute neutrophil count 900/mm³

Q7. A client on atorvastatin reports severe muscle pain and dark, tea-colored urine. What is the best response?

• Reassure that myalgias are expected and encourage continued exercise
• Advise taking the statin in the morning instead of bedtime
• Hold the medication and notify the provider for suspected rhabdomyolysis
• Increase dietary potassium intake to reduce cramps

Correct Answer: Hold the medication and notify the provider for suspected rhabdomyolysis

Q8. A client on digoxin has nausea, blurred vision with yellow halos, and an apical pulse of 48/min. The digoxin level is 2.6 ng/mL. What should the nurse do?

• Administer the scheduled dose and recheck level in the morning
• Hold digoxin and notify the provider of possible toxicity
• Give atropine and continue the digoxin
• Administer potassium-wasting diuretics to lower serum potassium

Correct Answer: Hold digoxin and notify the provider of possible toxicity

Q9. A client treated with lithium for bipolar disorder develops diarrhea, ataxia, and coarse tremor. The most recent level is 1.9 mEq/L. What is the priority action?

• Hold the dose and initiate IV fluids as prescribed
• Administer the next dose with food to reduce GI upset
• Encourage a low-sodium diet to enhance lithium effect
• Instruct the client to increase exercise to reduce tremor

Correct Answer: Hold the dose and initiate IV fluids as prescribed

Q10. A nurse reviews medications for a client on theophylline. Which concurrent medication increases risk of theophylline toxicity?

• Aluminum hydroxide
• Cimetidine
• Docusate sodium
• Sucralfate

Correct Answer: Cimetidine

Q11. A client started on phenytoin develops a widespread rash with mucosal involvement. What is the nurse’s best action?

• Apply emollients and continue therapy
• Hold phenytoin and notify the provider for suspected Stevens-Johnson syndrome
• Administer diphenhydramine and document the rash
• Switch to extended-release phenytoin formulation

Correct Answer: Hold phenytoin and notify the provider for suspected Stevens-Johnson syndrome

Q12. A client on carbamazepine presents to clinic. Which finding requires priority intervention?

• Mild dizziness on standing
• White blood cell count of 2,000/mm³
• Gingival bleeding with brushing
• Mild nausea after meals

Correct Answer: White blood cell count of 2,000/mm³

Q13. A client on isoniazid therapy for latent TB reports fatigue, anorexia, and dark urine. Which lab supports an adverse drug effect?

• ALT 248 U/L
• Potassium 3.8 mEq/L
• Creatinine 0.8 mg/dL
• TSH 2.1 μIU/mL

Correct Answer: ALT 248 U/L

Q14. A client receiving amphotericin B shows a creatinine increase from 0.9 to 2.1 mg/dL and potassium of 3.0 mEq/L. What should the nurse do?

• Continue the infusion and recheck labs in 48 hours
• Stop the infusion and notify the provider of nephrotoxicity
• Administer furosemide to increase urine output
• Restrict fluids to prevent volume overload

Correct Answer: Stop the infusion and notify the provider of nephrotoxicity

Q15. A client takes lisinopril and spironolactone. Which ECG finding suggests a dangerous adverse effect?

• Prominent U waves
• Peaked T waves
• Prolonged QT interval
• Sinus tachycardia

Correct Answer: Peaked T waves

Q16. After using albuterol via MDI, a client reports tremors and palpitations. The nurse should respond by stating:

• These are expected effects; use before activity as prescribed
• Stop the medication immediately and come to the ED
• Increase the number of puffs to overcome the palpitations
• Switch to long-acting beta-agonist monotherapy

Correct Answer: These are expected effects; use before activity as prescribed

Q17. A client with type 1 diabetes is started on propranolol. Which sign of hypoglycemia will still be apparent despite beta-blockade?

• Tachycardia
• Tremors
• Diaphoresis
• Palpitations

Correct Answer: Diaphoresis

Q18. A client on nitroprusside infusion for hypertensive emergency develops confusion, headache, and metabolic acidosis. Which is the priority action?

• Increase infusion rate to improve cerebral perfusion
• Stop the infusion and notify the provider for possible cyanide toxicity
• Administer mannitol to reduce intracranial pressure
• Switch to nitroglycerin transdermal patch

Correct Answer: Stop the infusion and notify the provider for possible cyanide toxicity

Q19. A client receiving total parenteral nutrition develops excessive thirst, polyuria, and blurred vision. What adverse effect should the nurse suspect?

• Refeeding syndrome
• Hypoglycemia
• Hyperglycemia
• Electrolyte depletion of calcium

Correct Answer: Hyperglycemia

Q20. A client on gentamicin reports tinnitus and has a rising creatinine. Which action is most appropriate?

• Administer an additional dose to maintain peak levels
• Hold the dose and notify the provider to evaluate trough levels
• Encourage increased fluid intake and continue therapy
• Switch to another aminoglycoside

Correct Answer: Hold the dose and notify the provider to evaluate trough levels

Q21. A client taking high-dose furosemide complains of muscle weakness. Which assessment supports a drug adverse effect?

• Serum potassium 2.9 mEq/L
• Serum sodium 140 mEq/L
• Serum magnesium 2.0 mg/dL
• Blood glucose 92 mg/dL

Correct Answer: Serum potassium 2.9 mEq/L

Q22. A client receives insulin before breakfast and becomes diaphoretic, shaky, and anxious mid-morning. Which is the best immediate intervention?

• Administer 15 g of fast-acting carbohydrate
• Give long-acting insulin to stabilize glucose
• Encourage water intake and reassess in 30 minutes
• Call the provider for IV dextrose order without further assessment

Correct Answer: Administer 15 g of fast-acting carbohydrate

Q23. A client on phenelzine ate aged cheese and now has severe occipital headache and hypertension. What adverse reaction is suspected?

• Serotonin syndrome
• Hypertensive crisis due to tyramine interaction
• Neuroleptic malignant syndrome
• Hypotensive crisis from MAOI overdose

Correct Answer: Hypertensive crisis due to tyramine interaction

Q24. A client on sertraline starts linezolid therapy. Which combination effect is the priority concern?

• Ototoxicity
• Serotonin syndrome with hyperreflexia and fever
• QT interval shortening
• Severe constipation

Correct Answer: Serotonin syndrome with hyperreflexia and fever

Q25. A client on haloperidol has a temperature of 39.7°C (103.5°F), severe rigidity, and altered mental status. What is the nurse’s priority?

• Administer antipyretics and continue haloperidol
• Stop haloperidol, notify provider, and prepare for supportive care and dantrolene
• Provide cooling blanket and reassess in 4 hours
• Administer benztropine and continue monitoring

Correct Answer: Stop haloperidol, notify provider, and prepare for supportive care and dantrolene

Q26. A client stabilized on warfarin is prescribed trimethoprim-sulfamethoxazole for UTI. What is the best nursing action?

• Continue both medications without changes
• Hold warfarin for 24 hours and reassess pain
• Notify the provider due to increased bleeding risk and anticipate INR monitoring
• Encourage increased vitamin K intake to compensate

Correct Answer: Notify the provider due to increased bleeding risk and anticipate INR monitoring

Q27. A client on hydrochlorothiazide reports lethargy and confusion. Which laboratory value indicates an adverse effect requiring action?

• Sodium 128 mEq/L
• Chloride 104 mEq/L
• Calcium 9.4 mg/dL
• Uric acid 6.0 mg/dL

Correct Answer: Sodium 128 mEq/L

Q28. The nurse reviews new prescriptions. Which combination should be questioned due to high risk of profound sedation and respiratory depression?

• Acetaminophen and ondansetron
• Oxycodone and diazepam
• Metformin and lisinopril
• Atorvastatin and ezetimibe

Correct Answer: Oxycodone and diazepam

Q29. A client on a norepinephrine infusion via peripheral IV develops a cool, pale, and painful IV site with blanching. What is the nurse’s immediate action?

• Stop the infusion and notify the provider for possible extravasation
• Apply warm moist compresses and continue the infusion
• Elevate the extremity and increase the infusion rate
• Flush the IV briskly with normal saline

Correct Answer: Stop the infusion and notify the provider for possible extravasation

Q30. Ten minutes after a packed RBC transfusion starts, the client reports chills, low back pain, and has hypotension. What is the priority action?

• Slow the infusion and reassess in 15 minutes
• Stop the transfusion, keep the IV open with normal saline using new tubing, and notify the provider
• Administer acetaminophen and continue the transfusion
• Elevate the head of bed and administer oxygen only

Correct Answer: Stop the transfusion, keep the IV open with normal saline using new tubing, and notify the provider

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